title: Advanced catheter technology: is this the answer to overcoming the long learning curve in complex endovascular procedures.
abstract: BACKGROUND
  Advanced endovascular procedures require a high degree of skill with a long learning curve. We aimed to identify differential increases in endovascular skill acquisition in novices using conventional (CC), manually steerable (MSC) and robotic endovascular catheters (RC).
  
  
  METHODS
  10 novices cannulated all vessels within a CT-reconstructed pulsatile-flow arch phantom in the Simulated Endovascular Suite. Subjects were randomly assigned to conventional/manually-steerable/robotic techniques as the first procedure undertaken. The operators repeated the task weekly for 5 weeks. Quantitative (cannulation times, wire/catheter-tip movements, vessel wall hits) and qualitative metrics (validated rating scale (IC3ST)) were compared.
  
  
  RESULTS
  Subjects exhibited statistically significant differences when comparing initial to final performance for total procedure times and catheter-tip movements with all catheter types. Sequential non-parametric comparisons identified learning curve plateau levels at weeks 2 or 3(RCs, MSCs), and at week 4(CCs) for the majority of metrics. There were significantly fewer catheter-tip movements using advanced catheter technology after training (Week 5: CC 74 IQR(59-89) versus MSC 62(44-81); p = 0.028, and RC 33 (28-44); p = 0.012). RCs virtually eliminated wall hits at the arch (CC 29(28-76) versus RC 8(6-9); p = 0.005) and produced significantly higher overall performance scores (p < 0.02).
  
  
  CONCLUSIONS
  Advanced endovascular catheters, although more intricate, do not seem to take longer to master and in some areas offer clear advantages with regards to positional control, at a faster rate. RCs seem to be the most intuitive and advanced skill acquisition occurs with minimal training. Robotic endovascular technology may have a significantly shorter path to proficiency allowing an increased number of trainees to attempt more complex endovascular procedures earlier and with a greater degree of safety.
authors.affiliation: Regional Vascular & Endovascular Unit, Imperial College London, United Kingdom. c.riga@imperial.ac.uk
authors.forename: C V
authors.initials: CV
authors.lastname: Riga
authors.forename: C D
authors.initials: CD
authors.lastname: Bicknell
authors.forename: R
authors.initials: R
authors.lastname: Sidhu
authors.forename: F
authors.initials: F
authors.lastname: Cochennec
authors.forename: P
authors.initials: P
authors.lastname: Normahani
authors.forename: P
authors.initials: P
authors.lastname: Chadha
authors.forename: E
authors.initials: E
authors.lastname: Kashef
authors.forename: M
authors.initials: M
authors.lastname: Hamady
authors.forename: N J W
authors.initials: NJ
authors.lastname: Cheshire
mesh_terms: D002404:Catheterization; D057785:Catheters; D003198:Computer Simulation; D057510:Endovascular Procedures / Q000193:education*; D004867:Equipment Design; D006801:Humans; D059032:Learning Curve; D012371:Robotics